Literature review

FACTORS INFLUENCING
INTRAOCULAR PRESSURE
Meidina Rahmah
Consultant
Dr. dr. Hj. Fidalia, SpM(K)
dr. Prima Maya Sari, SpM
OPHTHALMOLOGY DEPARTMENT OF SRIWIJAYA
UNIVERSITY
MOH. HOESIN HOSPITAL PALEMBANG
2015

Introduction
Normally intraocular pressure is
15.5 mmHg with SD 2.6 mmHg
Intraocular pressure are influenced
by secretion and outflow of
aqueous humor
Aquos humor is a fluid which
filled anterior and posterior
chamber

.. Introduction
Disturbance of aqueous humor flow can
cause increasing of intraocular pressure
which lead to optical nerve damage
Its important to know aqueous humor
flow and factors that influenced the
intraocular pressure

Objective
To explain about anatomy ciliary
body and anterior chamber,
physiology of aqueous humor and
factors that influenced intraocular
pressure

Anatomy & Physiology

Anatomy of the Ciliary Body

Site of aqueous humor production
Anterior portion of the uveal tract, which
is located between the iris and the
choroid
Consist of 2 zone anterior (pars
plikata) & posterior (pars plana)

.. Anatomy
longitudinal

Ciliary Muscle

circular
oblique

Ciliary Vessels

.. Anatomy
The major arterial circle is the immediate
vascular supply of the iris and ciliary
processes
Each ciliary process is supplied by two
branches of the major arterial circle:
the anterior and posterior ciliary process
arterioles

Ciliary Epitel
Outer part pigmented epithelium, consist
of cuboid cell and facing the stroma of the
ciliary process
Inner part non pigmented epithelium,
consist of collumnar epithelial, facing and
lining the posterior chamber

Innervation of the Ciliary Body

Simpatis
Synapse in the
superior cervical
Ganglion
Postsynaptic fibers
are distributed to
the ciliary body
vessels

Parasimpatis
Edinger-Westphal
nucleus to
innervate the
ciliary muscles

Anatomy of Anterior Chamber

The iris separates the aqueous humor
compartment into a posterior and an
anterior chamber
A ngle formed by the iris and the cornea is called
the anterior chamber angle
The deep of anterior chamber is vary
In normal emetrop 3 mm
Volume 200 L

.. Anatomy
Anterior chamber angle is formed by:
Schwalbes line
Schlemms canal and Trabecular
meshwork
Scleral spur
Collector channel
Anterior border of the cilliary body
Iris

Schwalbes line
- Termination of Descemets membrane

Schlemms canal
- A continuos monolayer of nonfenestrated
endothelium and thin connective tissue wall

Trabecular meshwork
Consists of a connective tissue core
surrounded by endothelium and may be
divided into three portions:
(a) uveal meshwork,
(b) corneoscleral meshwork,
(c) juxtacanalicular tissue

Physiology
Aqueous humor is a clear fluid that fills
and helps form the anterior and posterior
chambers of the eye
Secreted by the nonpigmented ciliary
epithelium (NPE) from a substrate of
blood plasma.

.. Physiology
Intraocular pressure is depend on:
1. Rate of aqueous secretion
2. Resistance of the outflow
channel
3. Episcleral venous pressure

Functions of aqueous humor

Brings oxygen and nutrients to cells of lens,
cornea, iris
Removes products of metabolism and toxic
substances from those structures
Provides mechanism for maintaining intraocular
pressure
High ascorbate levels protect against ultravioletinduced oxidative products, e.g., free radicals
Facilitates cellular and humoral responses of eye
to inflammation and infection

Aqueous Humor Formation

3 mechanisms

Aqueous Humor Composition

Inorganic ion and organic
anion
Carbohydrate
Glutation and urea
Protein
Growth modulary factors
Oxygen and CO2

Components

Plasma

Aquos

Vitreus

Na+

146

163

144

Cl-

109

134

114

HCO3-

28

20

20-30

0,04

1,06

2,21

3,4

(mmol/kg H20)

Ascorbate
Glucosa

Aqueous Humor Outflow

A queous humor posterior chamber
pupil anterior chamber.
Aqueous humor exits the eye by passing
through the 2 route:
1.The trabecular (conventional) route
(90%)
2. The uveoscleral (unconventional) route
(10%)

Factors that influenced intra

ocular pressure
Increase intraocular pressure
Gender
Diurnal variation
Cardiovascular
Position
External pressure of eyeball

Factors that may increase intraocular pressure

Increasing of episclera vein pressure
Manuver Valsava
Hold to breath
Usage of tight collar atau tight necktie
Increase central vein pressure
Obstruction outflow of orbital vein
Intubation
Pressure on eyeball
Blefarospasme
Crying
Hyperthermia
Hormonal
Hipotiroidisme
Thyroid eye disease
Drugs unrelated to glaucoma therapy
Lysergic acid diethylamide (LSD)
Topiramate
Corticosteroids
Anticholinergics
Ketamine

Decrease intraocular pressure

Age
Exercise
Trauma and inflamation

Factors that may decrease intraocular pressure

Aerobic exercise
Anesthetic drugs
Depolarizing muscle relaxants such as
succinylcholine
Metabolic or respiratory acidosis
Hormonal influences
Pregnancy
Drugs unrelated to glaucoma therapy
Alcohol consumption
Heroin
Marijuana (cannabis)

Conclusion
Intraocular pressure are influenced by
secretion rate of aqueous humor and
rate of outflow
This fluid flow from posterior chamber
pupil anterior chamber trabecular
patyhway and uveoscleral pathway
Intraocular pressure depends on many
factors that may increase dan decrease

Thank
You